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Related Experiment Videos

Dynamic cardiomyoplasty at seven years

A Carpentier1, J C Chachques, C Acar

  • 1Hôpital Broussais, Paris, France.

The Journal of Thoracic and Cardiovascular Surgery
|July 1, 1993
PubMed
Summary

Dynamic cardiomyoplasty improved heart function in 52 patients with end-stage heart disease. This surgical technique, using the latissimus dorsi muscle, reduced mortality and improved functional class, ejection fraction, and quality of life.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Regenerative Medicine

Background:

  • End-stage heart disease significantly impacts patient prognosis and quality of life.
  • Dynamic cardiomyoplasty is a surgical intervention aimed at improving cardiac function in severe heart failure.
  • The latissimus dorsi muscle flap is utilized to augment ventricular function.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of dynamic cardiomyoplasty in patients with end-stage heart disease.
  • To assess the impact of the procedure on mortality, functional status, and cardiac performance.
  • To identify predictors of hospital and long-term mortality.

Main Methods:

  • A cohort of 52 patients with end-stage heart disease underwent dynamic cardiomyoplasty between January 1985 and April 1992.

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  • Procedures included ventricular reinforcement or substitution using the left latissimus dorsi muscle, with or without associated cardiac surgeries.
  • Patients were followed for up to 7 years, with assessments of mortality, functional class (New York Heart Association), ejection fraction, and quality of life.

    • Main Results:

    • Early mortality (pre-stimulation) decreased significantly from 54% (1985-1987) to 12% (1988-1992).
    • Post-assist mortality was 20%. Key predictors of hospital mortality included age, surgical complexity, biventricular failure, and hemodynamic instability.
    • Long-term survivors showed significant improvements: New York Heart Association class improved from 3.3 to 1.8, ejection fraction increased, and rehospitalizations for heart failure decreased.
    • Actuarial survival at 7 years was 70.4% (excluding pre-assist mortality).

    Conclusions:

    • Dynamic cardiomyoplasty, particularly with improved surgical timing and patient selection, can significantly improve long-term survival and functional capacity in selected patients with end-stage heart disease.
    • Risk factor identification is crucial for optimizing patient selection and surgical outcomes.
    • The procedure leads to sustained improvements in cardiac function and quality of life, with reduced need for pharmacologic support.